November 2010 Newsletter
5010 in 2010
The Fall has always been a season of change, and this year is no exception. The biggest change looming on the proverbial horizon for Fall 2010 is the transition from the ANSI 4010A1 electronic format to the new ANSI 5010 format.
For almost a full year now, Quadax has been in dialogue with payers and clients regarding this switch. While a few payers are prepared to accept the new format, many are still scrambling to assess what they need to do to accommodate it. The common sentiment from clients seems to be that this change still seems too far in the future to worry about. However, the New Year is right around the corner and the transition to 5010 isn’t far behind!
Much like the transition to the 4010A1 format, several steps need to be in place before Quadax can “go live” with the implementation of 5010. The first piece of the “puzzle” is already available: the ANSI 5010 Implementation Guide, published by the government. Although this Guide should establish a single standard for all payers to follow for all electronic transactions (e.g. 837, 835, 277, etc.), our experience dealing with the transition to the ANSI 4010 format indicates otherwise. The reality is payers often have different interpretations of the Implementation Guide as well as unique claim requirements that may contradict and/or supersede the Implementation Guide, as was the case with the switch to ANSI 4010. These provisions and alterations are contained in individual payer Companion Guides. Consequently, Quadax must wait until payers publish their ANSI 5010 Companion Guides before any changes can be made and testing begun by us. In short, Quadax will transition to 5010 as soon as the individual payers are ready.
The official implementation date of the new ANSI 5010 requirements is January 1, 2012, but payers can make the transition to the 5010 as early as January 1, 2011. For example, CMS Transmittal 648 (CR 6851) indicates that in conjunction with the transition to the 5010 format, Medicare will start handling up to 24 Diagnosis Codes, 24 POA Codes, and up to 24 ICD-9 Procedure Codes on UB claims, effective January 1, 2011. It has also published Special Edition MLN Matters Article #SE1029 to advise ambulance suppliers how to submit their claims electronically in light of new requirements, effective for claims submitted in the version 5010 837P electronic claim format on the same date. In addition, Quadax has already received a 5010 format remittance file from Emdeon and is in the process of performing internal 5010 remit tests with this new data in preparation of the impending transition. In all three cases, Quadax will be ready to accommodate these changes on January 1, 2011.
Impact on Quadax Applications
HARP/PAS/OnBase
Meeting the 5010 requirements will necessitate changes to the HARP, PAS, and ECM applications. We anticipate implementing enhancements to the applications well in advance of the transition deadline. Your account representative will work with you directly to identify any updates needed to client-specific interfaces.
Xpeditor
The majority of the changes necessary to transition EDI transactions to 5010 will be made “behind the scenes” and will not incur a fee. For example, Quadax will not charge for the addition of new fields in Xpeditor, the creation of databases to accommodate new ANSI 5010 data, the creation/modification of existing edits, or the conversion of clients’ incoming 837 files in the ANSI 4010A1 format to the ANSI 5010 format. However, changes required for client-specific logic in Xpeditor, such as custom converts and custom edits, are chargeable items.
Remember: The best way to ease the transition to ANSI 5010 is to notify Quadax as soon as possible when you are ready to convert so that we can test the new format and make the necessary changes! Be sure to contact your Quadax account representative with questions or concerns about this important changeover.
See the related article in this issue: Transition to ICD-10.